Barriers to cervical cancer screening and experiences using mailed at-home HPV self-collection kits among US and foreign-born Hispanic women in a safety net health system

OBJECTIVE: Mailed self-collection for human papillomavirus (HPV) testing can increase cervical cancer screening among underscreened women, though barriers differ by subgroup. Hispanic/Latina women, especially foreign-born, have lower screening rates than non-Hispanic white women. This study compared barriers to Papanicolaou (Pap) screening and experiences with mailed HPV self-collection among underscreened foreign-born Hispanic, US-born Hispanic, and US-born non-Hispanic women in a safety-net health system. METHODS: We analyzed survey data from a randomized trial of mailed HPV self-collection among women aged 30-65 years who were overdue for screening. Participants received an at-home kit and completed a telephone survey in English/Spanish. Barriers and experiences were compared using chi-squared tests. RESULTS: Of 256 participants, 64.1% were foreign-born Hispanic, 12.1% US-born Hispanic, and 23.8% US-born non-Hispanic. Foreign-born Hispanic women had increased prevalence of self-reported barriers to Pap screening-including discomfort with male providers, embarrassment, pain, appointment and transportation difficulties, uncertainty about screening intervals, and fear of cancer or HPV. Experiences with self-collection were similar across all groups: most participants reported a good experience, a willingness to use it again, and a willingness to recommend it. However, foreign-born Hispanic women were more likely to express concerns about proper sample collection, safety, and confidentiality. CONCLUSIONS: Barriers to traditional cervical cancer screening across several categories, including discomfort and embarrassment, lack of knowledge or healthcare access, and fear of cancer, were more prevalent among foreign-born Hispanic women than among the other groups. While experiences with self-collection were generally positive across the three groups, the prevalence of barriers was higher among foreign-born Hispanic women.